| NPI | 1528513066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 277000512) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: ID 209014731) |
| Enumeration Date | 2016-08-24 |
| Last Update Date | 2024-02-02 |